General Discussions

Making Decisions About Value of Cancer Treatments

By Lisa Schulmeister, RN, MN, APRN-BC, OCN, FAAN

PUBLISHED THURSDAY, JANUARY 1, 1970

The American Society of Clinical Oncology (ASCO) assembled a task force to address the value of cancer treatment and developed a conceptual framework to guide physician–patient discussions about the value of the proposed treatment. ASCO’s Value in Cancer Care Task Force was guided by the core principles of the importance of the physician–patient relationship, informed decision making by patients, and physician advocacy. Because patient perception of value is so individualized, the task force noted that discussions with patients should include an assessment of which treatments are most likely to support the patient’s needs, goals, and preferences, and that information is provided as transparently as possible.

The task force developed two frameworks to date, one for advanced disease and the other for potentially curative treatment. The frameworks are presented as scorecards, and as an example, the advanced disease framework considers overall survival likelihood or response rate (used to calculate a clinical benefit score) and toxicity scores. Bonus points are given for data supporting palliation of symptoms and treatment-free intervals. The net health benefit is then determined, and the regimen’s cost (eg, copay, drug acquisition cost) is then added. The scores are entered across the bottom of the framework, and these data can then be used to guide the physician–patient discussion about treatment options. The task force notes that the relative value of a specific cancer treatment is likely to change over time, and invites public comments until August 21, 2015 at www.asco.org/value.